optoblog.com

MedGadget reports that optical coherence tomography helps diagnose and manage multiple sclerosis, and they display an HRT2-3 picture.
So my HRT2 may still have legs! Now I’ll get the referrals from the neurologist (to use my HRT2) instead of the other way around!
I’m sure they’ll charge extra for the stats package that helps manage MS. But listen to this:

In addition, says Calabresi, OCT scans take roughly one-tenth as long and cost one-tenth as much as the MRI, which means they are faster and cheaper to use in studies that track the effectiveness of new treatments for MS.

They must have really cheap MRI’s where he comes from. The average price in my neck of the woods for optic nerve imaging with Stratus OCT, HRT2-3, or GDx is ~$80-90 for both eyes. Do you know of any place that just charges $800-900 for an MRI? I believe it’s more like $1200. Also, you’d have to additionally pay a Radiologist to give an interpretation and report, but the optic nerve imaging fee includes the report.

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So I went to the bank today and the new teller said, “So you’re an optometrist. What’s the grossest thing you’ve ever seen?”

I assumed she meant personally, so I didn’t answer anything about what I’ve seen in text books or CE.

“Well, I haven’t had to see a lot of gory stuff since I’m an optometrist and not a surgeon…but I’d have to say something that gave me the willies was crab lice on the eyelashes. That’s an STD.”

You should have seen the look on her face. Her reaction was a combination of shock and disgust. She said, “Oh gross.”

Then she turned to her co-worker running the drive through and said, “Did you here that?”

Yep, she was so appalled that she had to share it with others.

Next time I’ll just keep it simple and say something like, “Well, there was this really, really red eye. I mean really red…”

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Apparently there is no corporate sponsored campaign against the Biofinity contact lens (see my earlier post conjecturing that there could be).
My mistake.
I removed the name of the business “John” works at since apparently they have nothing to do with his personal comments. It turns out “John” is some actual person who must search the internet for mentions of Biofinity and if possible comment about his bad experience with it.
But I think it would be cool to run a grassroots internet comment campaign against a product. I would personally like to contribute any negative comments about low oxygen lenses. (By the way, I got a fancy letter from Vistakon this week saying they weren’t going to be giving away any more trial lenses on Acuvue original contact lens. What? Who even sells those anymore!?)
So I hope this teaches you all a lesson. Always supply your correct e-mail address (which only I see) when commenting so that I don’t think you are a secret corporate entity out to get me.

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I once heard this from a rep, and this cartoon was immediately spawned in my brain.

And I know that women don’t normally buy the engagement ring, and yes, I just use the same pictures and change the words.

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Seriously, would it be okay if we farmed out patient education on presbyopia to the techs or opticians or something? Are eye doctors the only ones on the planet who have ever heard of it? From the 40-something mildly farsighted patients especially I get these incredulous looks.

“But I’ve never needed glasses in my entire life!” they say.

If they can mandate that my child take sex ed in school, why can’t they mandate that everyone be forewarned about the whole presbyopia thing? I remember in second grade health class learning about the digestive tract with a slide show of a cartoon character traveling down a river on brown barrels. Why can’t they do a little ditty about the eyes too?

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Here’s another example of why everyone should consider getting a yearly eye exam despite what Canadian studies say. A college student came in for a routine eye exam to get more contacts since the last doctor made her contact prescription expire only after a year. Everything seemed normal except that this year she didn’t pass the FDT screening field with one eye and that same eye had 20/30 vision. The ONH looked a little pale and both were elevated.

If I was still in Indian Health Service, I could have handled this myself- ordering all kinds of fun tests. But what I’ve learned out in the private sector is that insurance companies HATE it when optometrists order tests. Patients get denial letters on labs. Forget about imaging. Besides, I was having a train wreck day, so I just punted to the ophthalmologist.

Turns out that an MRI ordered by the OMD diagnosed a brain tumor that would have killed her if allowed to fester. I know that because she stopped by last week on a day that I wasn’t there to say thank you. When I heard that, I felt ashamed. I should have been the one to piece together the information and order the scans and have the burden to tell her the bad news.

But regardless of my personal shame, the patient is now okay. She is yet another shining example of why Utah state law should not mandate to me that I have to make prescriptions good for two years. I saw her chart from previous years. No VF defects, 20/20 vision in both eyes- no indication that the next year she would be diagnosed with brain cancer.

Hey 1-800 and your lobbiests! Who knows how many people you will kill or blind because you force by law that every eye doctor in the state of Utah has to make their Rx’s for 2 years.

So everyone: check yearly, see clearly, live longer.

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This is what I wish I could say to patients when they ask about private practice glasses prices. Do you ever feel like we’re being sold out by the very lens companies that say they’re looking out for us? For example, Wal-Mart sells lenses for cheaper than I can buy them from my lab. How does that happen?

What if a whole bunch of private practices started a co-op lab so that all profits from the lab go to the doctors? Or is Red Tray Optical the answer?

I like the consignment deal that VSP offers with their line of glasses. Why should I have to pay for frames that haven’t sold? Since frames now days look so freaking wacked, I think all frame vendors should work on consignment.

All I know is that doctors seem to be getting the short end of the stick while the frame and lens makers are assured their cash. I don’t see a profit motive for Big Lenses to help out private practice docs since commercial makes them more money overall.

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At my round of golf after some CE a couple weeks ago, the topic of conversation drifted to what practice management software was everyone using. Of course, for years we have been inundated with PIM/EHR software ads in industry magazines and booths at conferences and conventions. I still haven’t seen an appreciable improvement in the EHR part of the package. Sure, the PIM helps me track the money, but the EHR still slows me done. It would be faster to draft a paper chart and then scan it under the patient’s name in the PIM.

The whole reason to utilize a database for EHR would be to track numbers over time. For example, OfficeMate has this feature in the fields of IOP and C/D ratio. BUT THE WHOLE CHART SHOULD BE THIS WAY! And it would be great to have the functionality to analyze binocular testing data according to OEP, graphical, and normative analysis.

Anyway, if your EMR is just basically storing text for you instead of inserting data into searchable/analyzable database fields, I think it’s faster to scan your paper copy and link it into the PIM instead. Plus it will save you money on buying a separate EMR module.

Here were EHR wants number one and two.

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